70
A. STEROIDAL
Notes: 1) Suspensions are more lipophilic and penetrate the cornea more easily that solutions
2)Relative anti-inflammatory potency as follows:
Intravenous or intravitreal |
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Topical |
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cortisone |
0.8 |
low potency: |
cortisone |
cortisol (endogenous) |
1 |
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hydrocortisone |
hydrocortisone (synthetic) |
1 |
mild potency: |
fluorometholone |
prednisone |
4 |
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medrysone |
prednisolone |
4 |
moderate potency: |
fluorometholone acetate |
methylprednisolone |
5 |
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dexamethasone phosphate |
triamcinolone |
5 |
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rimexolone |
betamethasone |
25 |
high potency: |
loteprednol etabonate |
dexamethasone |
25 |
higher potency: |
prednisolone phosphate |
fluorometholone |
40–50 |
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dexamethasone acetate |
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highest potency |
prednisolone acetate |
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difluprednate |
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(1) Topical
Drug |
Trade |
Preparation |
Usual Dosage |
cortisone |
Cortone |
used primarily for dermatologic/rheumatologic conditions |
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dexamethasone acetate |
AK-Dex, Decadron |
Susp, 0.1% |
variable |
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AK-Dex, Decadron |
Oint, 0.05% |
variable |
dexamethasone phosphate |
Decadron, AK-Dex |
Soln, 0.1% |
variable |
difluprednate |
Durezol |
Emulsion, 0.05% |
QID but dose varies (QID dosing equivalent to |
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prednisolone 8 times per day for uveitis)* |
fluorometholone |
Fluro-op, FML |
Susp, 0.1% |
QOD-QID |
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FML Forte |
Susp, 0.25% |
QOD-QID |
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FML S.O.P. |
Oint, 0.1% |
QD-QID |
fluorometholone acetate |
Eflone, Flarex |
Susp, 0.1% |
QOD-QID |
hydrocortisone |
exists only in combination with antibiotic |
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loteprednol etabonate |
Alrex |
Susp, 0.2% |
QD-QID |
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Lotemax |
Susp, 0.5% |
variable |
medrysone |
HMS |
Susp, 1% |
QD-Q4 hrs |
prednisolone acetate |
Pred Mild |
Susp, 0.12% |
variable |
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Econopred |
Susp, 0.125% |
variable |
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Pred Forte, Econopred Plus |
Susp, 1% |
variable |
prednisolone phosphate |
AKPred, Inflammase Mild, |
Soln, 0.125% |
variable |
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Pred-Phosphate |
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AKPred, Inflammase Forte, |
Soln, 1% |
variable |
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Pred-Phosphate |
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rimexolone |
Vexol |
Susp, 1% |
variable |
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* Jamal KN and Callanan DG. Clinical Ophthalmology 2009;3:381–390
Anti-Inflammatory Agents 71
(2) Subtenons/Intravitreal/Systemic |
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72 |
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Drug |
Trade |
Preparation |
Usual Dosage |
Notes |
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triamcinolone |
Kenalog |
40 mg/ml |
0.5–1.0 ml for |
subtenons or intravitreal for uveitis and CME; |
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Triescence |
40 mg/ml |
SubTenon’s |
lasts weeks to months; Triescence and |
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Trivaris |
80 mg/ml |
0.1 ml total vol for |
Trivaris are preservative-free formulations. |
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intravitreal to a |
Also used for vitreous visualization during |
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total dose |
vitrectomy |
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typically between |
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4–25 mg |
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betamethasone |
Celestone |
6 mg/ml |
0.5–1.0 ml |
subtenons post-cataract surgery, corneal |
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transplant, uveitis, and CME; last few days to |
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one week |
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dexamethasone |
N/A |
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0.4 mg in 0.1 ml |
intravitreal injection for endophthalmitis |
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acetate |
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dexamethasone |
Ozurdex |
Intravitreal implant |
0.7 mg |
Approved for treatment of macular edema |
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intravitreal |
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secondary to branch or central retinal vein |
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implant |
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occlusion and uveitis. Injected intravitreally |
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as outpatient procedure. Lasts 2–4 months. |
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fluocinolone |
Retisert |
Intravitreal implant |
0.59 mg |
Approved for treatment of chronic |
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acetonide |
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noninfectious uveitis. Inserted at pars plana |
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intravitreal |
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in operating room. Lasts 3 years. |
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implant |
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methylprednisolone |
Depo-Medrol, |
IV Soln |
See subject index for further discussion of giant cell arteritis, optic |
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Solu-Medrol |
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neuritis, and traumatic optic neuropathy |
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prednisone |
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1,2.5,5,10,20,50 mg |
variable |
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tabs |
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